Epidemiology

In general, oral mucositis (OM) occurs in up to 20% to 65% of adult cancer patients receiving conventional chemotherapy for solid tumours, up to 80% of patients receiving high-dose chemotherapy for haematopoietic stem cell transplantation (HSCT), and almost all patients receiving radiotherapy for head and neck cancer.[4] [5] [6]

The risk of OM after conventional chemotherapy for solid tumours is known to be associated with treatment regimen. One meta-analysis reported an OM incidence of 65% in patients with breast cancer treated with docetaxel plus doxorubicin plus cyclophosphamide (TAC), with severe OM occurring in 5%.[4]​ Among patients with lung cancer treated with platinum agent- or gemcitabine-based regimens, OM incidence was 15%, with severe OM reported in 1%. OM was reported in 14% of patients with colon cancer treated with fluorouracil-based chemotherapy, with severe OM occurring in 1.7%.

For HSCT, the severity of OM is associated with transplant type and conditioning regimen. One multi-centre study investigating OM incidence in patients undergoing HSCT reported that 71% were diagnosed with OM and 21.6% with severe OM following transplant.[7]​ The risk of severe OM was greater among adult patients receiving allogeneic HSCT compared with autologous HSCT (39.7% and 16.4%, respectively; P <0.001). In one systematic review investigating OM among allogeneic HSCT patients, severe OM occurred in 71.5% of patients treated with reduced-intensity regimens and in 79.7% of patients treated with myeloablative regimens (P <0.01).[8]

OM is an extremely common adverse effect of radiotherapy for head and neck cancer, occurring in virtually all patients.[3][9][10]​​ Frequency and severity is influenced by several factors including tumour site, radiation field and technique, and the use of concomitant chemotherapy.[11]​​ In one cohort study examining patient-reported OM after treatment with intensity-modulated radiotherapy, 62.5% of patients were found to have severe OM.[10]

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